Challenge of safety margin in laparoscopic liver resection for hepatocellular carcinoma

Abstract

Background Advances in minimally invasive surgical techniques and instrumentation have facilitated their application in the management of hepatic tumors. However, determination of the optimal safety margin can be challenging for liver surgeons. The present study used a case-matched analysis to evaluate the surgical margins and survival rates in patients with liver cancer treated using either laparoscopic or traditional liver resection. Methods All of the enrolled patients were diagnosed with hepatocellular carcinoma (HCC) after surgical resection, which was performed according to clinical practice guidelines. The indications for laparoscopy included the detection of a tumor at the anterior peripheral region of Segments III, IV, V, and VI, with a diameter of < 5 cm. Of all the enrolled patients, 86 (63 men and 23 women) underwent laparoscopic liver resection (Group I), whereas the remaining 91 (67 men and 24 women) underwent traditional open resection (Group II) based on case-matched study. Results The resection margins were ≥ 10 mm, 5–9 mm, and ≤ 4 mm in 1 patient, 70 patients, and 15 patients in Group I and 3 patients, 41 patients, and 47 patients in Group II, respectively. The safety margin was ≥ 10 mm in 15 Group I patients (17.4%) and 47 Group II patients (51.6%), respectively, (p = 0.001). The feasibility of wide resection was probably limited by the location of the tumor based adjacent to the main vessels. Overall, in Group I, the 1-, 3-, and 5-year survival rates were 84.2%, 67.3%, and 57.7% for a 5–9-mm safety margin and 93.3%, 86.7%, and 78.0% for a ≥ 10-mm safety margin, respectively; however, these differences were not statistically significant (p = 0.139). Similarly, in Group II, no significant differences were observed regarding the survival rates for varying safety margins (5–9 mm and 10 mm; p = 0.57). Conclusion Securing an appropriate safety margin for laparoscopic liver resection while dissecting using laparoscopic instruments was challenging without any tactile sensation by the surgeon. Moreover, no significant differences were observed in the postoperative survival of both Group I or II patients with a safety margin of ≥ 5 mm.